Clinical Experience with Eplerenone to Treat Chronic Central Serous Chorioretinopathy

Abstract

Purpose : Chronic central serous chorioretinopathy (CSC) is a major vision-threatening eye disease characterized by central subretinale fluid (SFR) for which there is still no approved treatment. Recent studies suggest that the corticosteroid pathway in the choroid is implicated in CSC pathogenesis, and that oral administration of the aldosterone antagonist eplerenone improves clinical outcome. However, there is still little clinical data to support this hypothesis. We performed a retrospective chart review to further investigate the clinical value of eplerenone treatment in patients with chronic CSC and to identify possible response predictors.

Methods : 24 patients with chronic CSC resistant to conventional therapy over at least 4 months were included in this retrospective study. Patients were initially treated with 25mg/day of oral eplerenone for one week, followed by a sustained daily dose of 50mg/day. The primary outcome measure was percentage of eyes achieving complete resolution of SRF recorded by optical coherence tomography (SD-OCT). Secondary outcomes included changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA). Furthermore, baseline SD-OCT images were evaluated for possible predictors of treatment response.

Results : 29% of patients experienced a complete resolution of SRF after a median of 106 days of treatment. 33% of patients showed a transient initial decrease in SRF, and 25% of patients failed to respond to treatment. Treatment had to be stopped in 13% of patients because of adverse effects of the eplerenone treatment. In the study population, CMT decreased from 342 to 275 µm after treatment, which was associated with a modest improvement in mean BCVA from 0.35 to 0.3 logMar. Integrity of the ellipsoid zone and the RPE at baseline were associated with a tendency for a favourable visual outcome.

Conclusions : This study confirms the proposed clinical value of eplerenone for treating patients with therapy-resistant CSC. However, patients presenting widespread RPE changes are less likely to benefit from eplerenone treatment, which may argue for an earlier intervention. Patient subgroups with the highest benefit of eplerenone treatment need to be characterized in subsequent larger studies.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.